I wish to have insurance information sent to me. (If you select yes, we will arrange to have insurance policy information sent to you when your membership is approved).

Yes
No

First Aid Expires On

Evidence

File Description

Police Check Expires On

Please do not upload the following checks Working with Children (WWCC), Working with Vulnerable People (WWVR) or Aged Care, we do not require a copies of these checks.

Police Check Evidence

File Description

Referral source

Referral source other

Join reason

Join reason other

Specialties

Active Release Technique

Acupressure

Aged Care/Elderly

Akupunkt Massage

Anxiety and Stress

Aromatherapy

Back and Neck Pain

Back Pain

Bowen Therapy

Chair Massage

Chinese Cupping Therapy

Chronic Pain Management

Clinical Relaxation

Complex Lymphatic Therapy

Corporate Massage

Corrective Exercise

Core Stability Training

Craniosacral Therapy

Cupping

Decongestive Lymphatic Therapy

Deep Connective Tissue Massage

Deep Tissue Massage

Dorn Spinal Therapy

Emmet Technique

Fascial Kinetics

Fibromyalgia

Flexibility and Strengthening

Foot Mobilisation

Hot Stone Massage

Infant and Paediatric Massage

Infant Massage

Infant Massage Instruction

Joint Mobilisation

Kinesio Taping

Lower Back Pain

Lymphatic Drainage

Lymphoedema Management

Manual Lymphatic Drainage

Migraine

Mobile Massage

Muscle Energy Technique (MET)

Myofascial Cupping

Myofascial Dry Needling

Myofascial Release

Myotherapy

Neck and Back Pain

Neck and Lower Back Pain

Neck Pain

Neurostructural Integration Technique (NST)

Oedema

Oncology Massage

Onsen Therapy

Oriental Massage

Orth-Bionomy

Orthopaedic Massage

Overuse Injuries

Pain Management

Personal Training

Pilates

Pregnancy Massage

Reflexology

Rehabilitation

Relaxation Massage

Remedial Massage

Rolfing Structural Integration

Rosen Method Bodywork

Scoliosis

Seated Massage

Shiatsu

Shoulder Pain

Sinus

SLM Bodywork

Soft Tissue Therapy

Spa Massage Treatments

Special Needs

Spiral Dynamics (Postural Correction)

Sports Massage

Sports Rehabilitation

Stress Management

Stretch Therapy

Structural Alignment

Structural Assessment

Structural Integration

Swedish Massage

TCM Remedial Massage (Tui Na)

Therapeutic Massage

TMJ Dysfunction

Trigger Point Therapy

Women's Health

Workplace Injuries

Men's Health

Mobile Visits?
Yes
No

Year Completed Qualification

Rto

Rto other

Course

Other course name

Qualification Evidence

File Description

Have you ever been a member of another professional association?
Yes
No
If yes, have you ever been expelled or sanctioned from that association?
Yes
No
Have you been the subject of any disciplinary, legal or criminal proceedings?
Yes
No
Are you aware of any pending disciplinary, legal or criminal proceedings?
Yes
No
Are you transferring from another professional association?
Yes
No

Other association proof

Other association provider

List three (3) character referees (name and telephone number) from persons other than family who have
known you for the last two years

Referee Name

Phone

Referee Name

Phone

Referee Name

Phone

Membership Level

Level

Fitness to Practice

Have you been the subject of any formal complaints or investigations over the past 12 months that would affect your fitness to practice as a massage therapist?

Have you been the subject of any disciplinary, legal or criminal proceedings over the past 12 months that would affect your fitness to practice as a massage therapist?

If you answered yes to either of these questions, please email a written explanation to
info@amt.org.au

Declaration Statements

I will abide by the AMT Code of Practice and the AMT Code of Ethics and any other applicable codes and regulations

I declare that the information given on this form is true and correct.
I understand that:

I must pay all my subscriptions and other monies due until I resign my membership

I declare that I will abide by the AMT Code of Ethics and any applicable rules, codes and regulations

I declare that I will abide by all applicable health fund provider terms and conditions

I declare that the information given on this form is true and correct.

Yes
No

Application Fee. This is a non-refundable fee, which must be sent with your Application :